What killed our soldiers in Afghanistan: Only two deaths preventable, study finds

Canada's Afghan mission had only two fatalities that may have been prevented by medics: study

Some bled to death from massive abdominal wounds, others suffered catastrophic brain injuries and many were thrown about so violently inside bomb-blasted armoured vehicles, their spinal cords were fatally severed.

The vast majority of Canadian soldiers killed in Afghanistan never had a chance, concludes a grim but revealing analysis of autopsy reports on many of the deaths, a rare look at information previously kept confidential.

Only two of the fatalities examined were considered potentially preventable; the wounded troops might have lived had medics managed to cut holes in their throats to allow them to breath after shrapnel penetrated and blocked airways, said the study.

It is unclear, though, whether combat conditions would have let medics perform a procedure that is challenging even for highly trained doctors, said Col. Homer Tien, an army trauma surgeon.

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“For a fourth-year surgical resident, a senior surgical resident, it’s a very daunting task to do in a well-lit trauma room,” said Col. Tien, who co-authored the research. “You’re cutting on someone’s throat. There’s a psychological barrier to get across.”

On the positive side, the death review underlines that Canadian medics performed extremely well, and injuries that killed routinely in earlier wars are now being effectively treated on the battlefield.

About 1,000 American GIs died in the Vietnam War because of bleeding from severed limbs, said Col. Tien, who doubles as head of the trauma unit at Toronto’s Sunnybrook Health Sciences Centre. All Canadian soldiers in the field in Afghanistan carried multiple tourniquets — an age-old tool that had been abandoned until recently.

“Everyone’s got tourniquets, everyone’s very well trained, so they’re slapping them on,” said Col. Tien. “These people with traumatic amputations that would have died previously in conflicts, they’re all surviving.”

Meanwhile, a separate study published in the same journal shows that most of the patients operated on at a Canadian-run combat hospital in Kandahar — now the subject of a Canadian TV series — were not NATO troops, but Afghans, many of them civilians.

The death study looked at the 73 soldiers killed in Kandahar from January, 2006, to April, 2008, the first two years of the Canadian mission in the southern Afghan province. (Another 95 Canadians have died in Afghanistan.)

Most of the troops died from blast injuries — the majority caused by IED explosions and rocket-propelled grenades, the study found. Another six were killed by gunshot wounds and five in road accidents.

The researchers obtained autopsy reports on 63 of the soldiers, and believe them to be representative of the overall death toll. The autopsies revealed that 17 died from severe brain injuries and three from spinal cord damage, the latter all blunt-force wounds suffered while inside armoured vehicles that were tossed about by IED explosions.

Just over 20 troops bled to death, most from torso wounds. Though the body armour now worn by soldiers repels most gunshots to the abdomen, explosions that erupt from underneath can wreak lethal damage on the torso, said Col. Tien.

One soldier who bled out had been injured in the groin area of the thigh, but it appears the entry wound was so small, there is little medics could have done, the study found. It would have been all but impossible, for instance, to apply the blood-clotting powder that was developed after an American soldier died from a similar injury in Somalia, an incident depicted in the book and film Blackhawk Down.

The study authors suggest alternative methods to curb hemorrhaging in such injuries, including inserting a urinary catheter — a small tube, essentially — and inflating the attached balloon.

Other troops died from decapitation and other “gross mutilation,” airway obstructions, multiple causes and the effects of fire.

Those who made it out of the battlefield alive were helicoptered to the so-called role-3 multinational medical unit at Kandahar Air Filed, the trauma centre Canada led from early 2006 to October, 2009, now featured in the Global-TV program Combat Hospital.

An analysis of the hospital’s caseload over that period, though, showed that more than 70% of patients were Afghans, a third of them civilians and another third Afghan soldiers and police. And 208 of the surgical patients were detainees captured by NATO troops.

The foreign forces made no concerted effort to offer up the unit’s services to the surrounding Afghan population – whose main hospital is a spartan, under-equipped facility – but anyone brought to the base with serious problems was treated, said Col. Tien.

For surgeons, work at the hospital involved a challenging array of procedures, from Caesarian sections to brain operations, that no doctor would face in Canada’s highly specialized medical system, he said. Col. Tien recalls a teenage Afghan patient he treated for a subdural haematoma, bleeding on the brain caused by a shrapnel wound, which required him to cut away a part of the skull and drain the blood.